You may not be as crazy as you think
Mental health surveys consistently show that around one in five of us will experience an episode of significant distress and dysfunction in any year. It saddens me that this suffering is mostly labelled as mental disorder and that we are encouraged to seek medical treatment for it.
No one likes suffering, but to suffer meaninglessly is worse. We should therefore strive to help people make sense of their distress; instead contemporary psychiatric practice is to rob actions and experiences of their meaning by applying simplistic labels and glib biological explanations.
Of course biological understanding can impart meaning, sometimes dramatically.
The recognition that many people in asylums had syphilis and the subsequent development of effective treatment for that disease radically changed the profile of psychiatry. It seems that many eminent psychiatrists believe that they will once more be able impart meaning to our patients’ suffering by some similarly impressive medical breakthrough.
I find this implausible. The brains of syphilitics were obviously and severely damaged. Some cases of severe mental illness may ultimately be attributable to similar if more subtle brain damage, but at present there are no consistent findings in the brain for even the most severe mental illnesses.
The vast majority of what is currently labelled as mental disorder only attracts that label because the person presents with symptoms resembling those of severe mental illness. But both a hard day at work and a brain tumour can cause a similar headache, just as both psychosis and emotional overload can manifest with panic attacks.
The meaning of suffering must be sought somewhere other than in the realm of biology. We should be suspicious of any approach that does not try to make sense of our experience. As a consequence of not doing so, how many women have been medicated for anxiety while the domestic violence that was making them anxious went unaddressed?
The high prevalence of suffering and its conceptualization of mental disorder scare our society into taking other potentially dangerous actions. One is the well intentioned investment in increasing mental health literacy in schools. These programs have positive aspects, such as teaching children to make better sense of their own and other peoples’ feelings. But they also teach teachers and students to identify mental disorder and refer it for professional attention.
This is a sad perversion of teachers’ critical role in child development. Schools are, after family, our society’s next most important institution for the well-being of children. For struggling children, school can be the difference between sinking or swimming.
But schools and teachers do not make this difference by identifying, responding to, and referring on mental disorders. They do so by offering a rich academic curriculum and the range of interpersonal interactions that are an essential part of school life, thereby helping give meaning to children’s experiences.
Perhaps the most important way that our families and schools can help children to become healthy individuals who can make sense of suffering is by promoting their capacity to create, tell and understand stories.
This narrative capacity develops through many activities including being read to, having our experiences recounted and explained to us and by telling our own and other people’s stories. In the words of AA Milne, the answer to the question, “What sort of stories does he like?” is “About himself. Because he’s that sort of Bear.” Most of us are.
It is our duty as therapists, family, friends and confidantes to help people build and make use of narratives whenever they encounter adversity. Not in the midst of trauma or grief, but afterwards, respecting the troubled person’s own sense of timing. And preferably not glib explanations such as ‘it is God’s will’ but stories that explain how they came to this point in life, to be suffering in this way.
Simplistic medical treatment might take away the pain more quickly but there is increasing evidence that it predisposes us to become more vulnerable to recurrence.
Facing up to the meaning of our suffering can be much more painful, but potentially immunises us against further distress.
Jon Jureidini will be speaking at the 2011 Adelaide Festival of Ideas (7-9 October).
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